Study: Consumption of Total and Specific Alcoholic Beverages and Long-Term Risk of Gout Among Men and Women. Image Credit: Nirat.pix / Shutterstock.com
A recent JAMA Network Open study assesses the association between total and specific alcohol consumption and incident gout in men and women.
Gout and alcohol consumption
Gout is the most common form of inflammatory arthritis and arises due to higher urate concentrations in the serum. The prevalence of gout varies across geographies and between men and women.
In addition to genetic factors, lifestyle factors also influence the development of hyperuricemia and gout. Alcohol consumption, for example, has been associated with elevated serum urate levels.
Prior research on this relationship is limited, as only men were included in the study cohort or utilized a cross-sectional or case-control design. Furthermore, existing studies have mainly used non-drinkers as the control group, which leads to reverse causality issues. Existing health issues could also cause an individual to abstain from alcohol, which could move them to “rarely-drinking” or “non-drinking” categories, thereby leading to bias in the association between gout risk and alcohol intake.
About the study
The current study involved the use of sex-specific analyses to investigate associations between the long-term risk of gout and total and specific alcohol intake.
The study included 401,128 United Kingdom Biobank participants who were free from gout at baseline and between 37 and 73 years of age. Follow-up was done through December 31, 2021, whereas data analysis was performed between August 2023 and June 2024.
Data on consumption of total alcohol and specific alcoholic beverages was obtained through a questionnaire. The primary study outcome variable was incident gout, identified using hospital health records.
Multivariable Cox proportional hazards regression models were estimated to obtain sex-specific hazard ratios (HRs) and 95% confidence intervals (CIs) of alcohol consumption-related incident gout.
Study findings
The final study cohort comprised 179,828 men and 221,300 women, most of whom were of Asian or Asian British, Black or Black British, and White racial or ethnic backgrounds. Among men and women, 93.6% and 90.5% were current drinkers, respectively, 3.6% were former drinkers, 2.9% and 5.9% never drank, respectively.
In the exploratory analysis, 6,561 and 2,078 incident cases of gout in men and women were observed, respectively, over a median follow-up period of 12.7 years. In the main analysis, 4,096 and 1,182 of the identified cases were women, respectively.
Among men, current drinkers were associated with an increased risk of developing gout in the exploratory analysis as compared to never-drinkers. Among women, this association was insignificant and inverse in the main analysis.
Among current male drinkers, the risk of gout was higher as the frequency of alcohol consumption increased. A positive association was only observed among women after body mass index (BMI) values were incorporated into the multivariable model.
Men consumed significantly more beer and cider than women. Beer or cider, white wine or champagne, and spirits were associated with a higher gout risk among both men and women, with the strongest association observed with beer or cider for both sexes.
Among women, the association between gout and spirits for every one measure each day was stronger than among men. Only among men was a positive association observed for consuming one glass of red wine every day; however, the association with fortified wine was insignificant.
In the exploratory analysis, light or moderate consumption of specific alcoholic beverages was significantly correlated with lower gout risk. In the main analysis, these associations were not present when adjusted for the possibility of reverse causality.
Conclusions
By carefully considering reverse causation, the current study identified a positive association between an increased risk of gout and the consumption of several specific alcoholic beverages among men and women. These sex-specific differences could be attributed to differences in the types of alcohol consumed rather than biological differences.
Despite the careful approach adopted in the current study, residual confounding could not be entirely eliminated. Furthermore, the self-reported nature of the study could lead to misclassification of exposure concerning the frequency of alcohol consumption could be present.
Other limitations include assessing alcohol intake only at baseline and the relatively low consumption of fortified wine in the study sample, which reduced the estimation power. Furthermore, most participants were of European descent, which could limit the generalizability of findings.
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